Provider Demographics
NPI:1780029348
Name:HOEHN, LYSA MARIE
Entity Type:Individual
Prefix:
First Name:LYSA
Middle Name:MARIE
Last Name:HOEHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2837
Mailing Address - Country:US
Mailing Address - Phone:516-379-0824
Mailing Address - Fax:
Practice Address - Street 1:1671 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:NORTH MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2837
Practice Address - Country:US
Practice Address - Phone:516-379-0824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY855210252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency